psychologywikiaorg-20200213-history
Alcoholics Anonymous
Alcoholics Anonymous (AA) is an informal society for recovering alcoholics. Members meet in local groups that vary in size from a handful to many hundreds of individuals. In 2001 there were 100,000 groups worldwide, making a global community of more than two million recovering alcoholics''Alcoholics Anonymous'' p 16. The stated primary purpose of the society is "to stay sober and help other alcoholics to achieve sobriety." AA teaches that an alcoholic, in order to recover, should abstain completely from alcohol on a daily basis;The AA Fact File, 'The Recovery Program'Alcoholics Anonymous : the story of how many thousands of men and women have recovered from alcoholism. 4th ed. New York : Alcoholics Anonymous World Services, 2001. ISBN 1893007162. Available online at www.AA.org the society in turn offers a community of recovering people who support each other by "sharing experience, strength and hope"AA Preamble and often by working the suggested Twelve Steps together. Alcoholics Anonymous was the first 12-step program and has been the model for similar recovery groups such as Al-Anon/Alateen, Gamblers Anonymous, Narcotics Anonymous, Sexaholics Anonymous, and Overeaters Anonymous. Al-Anon and Alateen are companion programs designed to provide support for relatives and friends of alcoholics. AA History Pre-AA understanding of alcoholism In the 1930s public opinion saw alcoholism as a moral failing. The medical profession's general view on alcoholism was characterized by hopelessness, a condition for which medical methods had "failed completely" and those who suffered from a chronic affliction were "doomed."William D. Silkworth, MD, Alcoholics Anonymous. p xxv-xxxiiii. Alcoholics Anonymous. AA World Services, Inc. 2001 Those without financial resources could find help only through state hospitals, the Salvation Army, and other charitable and religious groups. Those who could afford psychiatrists or hospitals were often subjected to a treatment with barbiturate and belladonna known as "purge and puke.""Bill W." —''Time's "Most Important People of the 20th Century". Susan Cheever. ''Time 153.23 (June 14, 1999): p201+. One contemporary doctor who would have a great influence on AA was William Duncan Silkworth, M.D, who specialized in the treatment of alcoholics. He contended that alcoholism is by nature an addiction which manifests itself as in two-fold ways, as both a mental obsession and a physical compulsion.William Silkworth, MD, Alcoholics Anonymous. p xxv-xxxiiii. Alcoholics Anonymous. AA World Services, Inc. 2001 The "obsession" of alcoholism is a mental state characterized by a desire to start drinking and repetitive thoughts of drinking, accompanied by a general sense of being "restless, irritable, and discontent" until alcohol is again ingested. William Silkworth, MD, Alcoholics Anonymous. p xxv-xxxiiii. Alcoholics Anonymous. AA World Services, Inc. 2001 The "compulsion" of alcoholism is a physical state characterized by a craving to continue drinking alcohol once the first drink had been ingested.William Silkworth, MD, Alcoholics Anonymous. p xxv-xxxiiii. Alcoholics Anonymous. AA World Services, Inc. 2001 In Silkworth's view, alcoholics suffer from the delusion that, despite the often severe consequences of the last drinking episode, no harm will be done by picking up the next drink. Silkworth believed that the two primary protectors of health —reason and will power— are of no use against this addiction.Dale Mitchel, Silkworth: The Little Doctor Who Loved Drunks. Hazelden, 2002. A search for a spiritual cure AA was founded by Bill Wilson, a Wall Street stock speculator, and Dr. Bob Smith, a proctologist from Akron, Ohio, both alcoholics. The chain of events that led to the meeting of these men began in Europe, where American business executive Rowland Hazard sought treatment for alcoholism with the famous Swiss psychiatrist Carl Jung. After a prolonged and unsuccessful period of therapy, Jung told Hazard that his case, like that of most alcoholics, was nearly hopeless—the only possibility for a cure was through spiritual conversion.Dale Mitchel. Pass It On: The Story of Bill Wilson and How the A. A. Message Reached the World Hazelden. 1984, p 381-385. Back in America, Rowland Hazard joined the Oxford Group, a Christian Evangelical association. The group advocated finding God through a spiritual surrender, moral inventory, confession of defects, elimination of sin, restitution, reliance upon God, and helping others. (Bill Wilson later gave credit for the concepts behind Steps Three through Twelve to the teachings of Rev. Samuel Moor Shoemaker of the Oxford Group. ) Through the Oxford group, Hazard underwent a spiritual conversion and achieved his long hoped for sobriety. The conversions of Thacher and Wilson Rowland Hazard introduced his acquaintance Ebby Thacher to Jung's conversion cure and the Oxford Group's spiritual principles, and Thacher, too, attained sobriety (although, in his case, it would not last his whole life''Alcoholics Anonymous Comes of Age (New York: Alcoholics Anonymous Publishing, 2004), p. 179). Thacher visited an old school friend by the name of Bill Wilson. Wilson was an alcoholic who had seen a promising career on Wall Street ruined by his drinking. He had failed to graduate from law school because he was too drunk to pick up his diploma. He had blown partnerships and business deals, all but destroyed his marriage, been hospitalized for alcoholism under the care of Dr. William Silkworth, and still continued to drink. Wilson was astonished to find that his old drinking companion had become sober through spiritual means, but he struggled with the existence of God. Then "My friend suggested what then seemed a novel idea. He said, 'Why don't you choose your own conception of God?' That statement hit me hard. It melted the icy intellectual mountain in whose shadow I had lived and shivered many years. I stood in the sunlight at last."Alcoholics Anonymous p 12 Wilson excitedly told his wife Lois about his spiritual discovery, yet the very next day he drank again, and eventually found himself back in hospital under Silkworth's care. According to Wilson, while lying in bed depressed and despairing he cried out, "I'll do anything! Anything at all! If there be a God, let Him show Himself!".Pass it on p 121. He then had the sensation of a bright light, a feeling of ecstasy, and a new serenity. Bill Wilson described his experience to Dr. Silkworth, who told him not to discount it and that he had noticed a differnce in his demeanor. Eby Thacher visited Bill Wilson at Townes hospital, introduced him to the basic tenets of the Oxford Group, and gave him a copy of Varieties of Religious Experience by American psychologist and philosopher William James, which described experiences similar to Wilson's. (Bill never could recall if it was Eby or Rowland who had given him the book) Upon his release from the hospital, Wilson admitted he was licked, got honest with himself, got honest with another, made amends, helped other alcoholics and prayed to whatever God he thought there was. (speech 1952 convention) William G Wilson never drank again for the remainder of his life. A new program for recovery In keeping with the practices of the Oxford Group, Wilson found that his own sobriety seemed to grow stronger when he shared his personal alcoholic experience with other alcoholics. At one point Wilson was on a business trip in Akron, OH, and was tempted to relapse. In a hotel lobby, he decided to phone local ministers and ask if they knew of alcoholics he could talk to. He eventually reached Oxford Group member Henrietta Seiberling, whose group had been trying to help alcoholic Dr. Bob Smith. Wilson met with Smith for what was planned as 15 minutes, and the two men talked late into the night. They became friends, and for three months they studied the Bible, held long discussions, and reviewed Oxford Group ideas, eventually fashioning a pioneer recovery program. Smith's last drink is said to have been on June 10, 1935—a beer to steady his hand for surgery—and that is considered within AA to be the date of the founding of AA. Wilson returned to New York, establishing a second group, he later revisited Akron and reviewed the movement with Smith. They estimated that by 1937, the two groups numbered forty recovered alcoholics with continuous sobriety''Alcoholics Anonymous Comes of Age (New York: Alcoholics Anonymous Publishing, 2004), p. 144, and decided with this success in mind, that they had a recovery program worth spreading. Impassioned discussions led to agreement that the essential communications tool would be in the form of a book. After great difficulties in raising the required funds for printing, a publishing company, Works Publishing Inc., was incorporated, and capital raised by selling shares to the groups’ members and friends. Wilson set to work writing the book. When he reached chapter five, he decided that a summary of their methods for treating alcoholism was needed to describe the Word of Mouth program. In these early days, the basic program had developed from the works of William James, Dr Silkworth and the Oxford Group (from which the AA groups separated in 1937''Alcoholics Anonymous Comes of Age (New York: Alcoholics Anonymous Publishing, 2004), p. 160), although several of the Oxford Group's ideas and attitudes were deliberately rejected, particularly any which would involve AA in theological controversy. The program involved an alcoholic: admitting that they were beaten by alcohol, making a moral inventory of their defects or sins, confessing their shortcomings with another person, making restitution to those harmed by the alcoholic's drinking, trying to help other alcoholics and praying to whatever God they believed in for the power to practice these precepts. Wilson, with contributions from others in the groups including several atheists who restrained the religious content, expanded these principles and the final version of the Twelve Steps was completed by the fall of 1938Alcoholics Anonymous Comes of Age ''(New York: Alcoholics Anonymous Publishing, 2004), p. 163. The "Big Book" The book, Alcoholics Anonymous, was published in 1939 and has been a perennial best-seller ever since. While several titles for the book were proposed (including "The Way Out", which was already in use), Bill Wilson and Dr. Bob finally settled on "Alcoholics Anonymous", and the fellowship itself took its name from the book. The first edition had a "circus cover" of red and yellow, and it was printed in heavy paper and had the margins brought in an additional inch making it fuller, which was thought to make it more attractive for the price—hence the nickname "Big Book", a name that sticks today with the same indented margins. Sales of the book—and the popularity of AA—increased rapidly after positive articles in Liberty magazine in 1939 Fulton Oursler. "Alcoholics and God." Liberty. September 30, 1939. and the Saturday Evening Post in 1941.Jack Alexander. "Alcoholics Anonymous." Saturday Evening Post. March 1, 1941. The 4th edition was released in 2001. The first 164 pages of the first edition, plus the preface, the forewords, and the chapter called "The Doctor's Opinion" have been left largely intact, with minor statistical updates and edits. In each successive edition, the personal stories have been reviewed to represent the current population of AA, with the result that the stories of the original members of the 1930s have gradually been displaced. In 2003 the stories removed from the first three editions of Alcoholics Anonymous were gathered together in the book "Experience, Strength, and Hope." The AA program AA provides support for members attending regular meetings. One description of meetings comes from Dr. W.W. Bauer, who spoke for the American Medical Association in 1946 when he stated "Alcoholics Anonymous are no crusaders: not a temperance society. They know that they must never drink. They help others with similar problems...In this atmosphere the alcoholic often overcomes his excessive concentration upon himself. Learning to depend upon a higher power and absorb himself in his work with other alcoholics, he remains sober day by day. The days add up into weeks, the weeks into months and years."Alcoholics Anonymous, Appendix III, p 570. The 12 Steps are sometimes summarized as "Trust God, clean house, and help others." AA members are encouraged to "work the Steps", usually under the guidance of a voluntary sponsor—a member who has experience working the program. The Steps are designed to help the alcoholic achieve a spiritual, emotional, and mental state conducive to lasting sobriety. Although the steps are based on seeking help from a higher power, atheists and agnostics have achieved long-term sobriety in AA, since AA offers freedom to follow one's own path.http://www.agnosticaanyc.org/faq.html Bill Wilson wrote a chapter in the "Big Book" entitled We Agnostics for alcoholics like him who were struggling with the idea of a Higher Power. "Working the program" might involve the following activities: * Above all, avoiding the first drink. "One is too many and a thousand never enough." * Regular attendance at meetings, and participation by talking or listening. Meetings are usually easy to find in large cities, and there are also AA meetings by phone, internet, and mail. For newcomers, 90 meetings in 90 days are often recommended to break the drinking habit and immerse them in a culture of sobriety. * Regular contact with a sponsor for support in staying and living sober and in working the program. * Service work, which can range from making coffee at meetings to attending national AA conferences. *Working the Twelve Steps. For new members the Steps are seen as a path of personal growth towards sobriety. Experienced members often rework all the steps at intervals of a few years, but they at a minimum usually carry out the following activities: ** Regular attention to personal inventory and admission of wrongs (Step Ten). ** Daily prayer and meditation (Step Eleven) ** Carrying the message to other alcoholics (Step Twelve). The 12 Steps of Alcoholics Anonymous # We admitted we were powerless over alcohol – that our lives had become unmanageable. # Came to believe that a Power greater than ourselves could restore us to sanity. # Made a decision to turn our will and our lives over to the care of God as we understood Him. # Made a searching and fearless moral inventory of ourselves. # Admitted to God, to ourselves and to another human being the exact nature of our wrongs. # Were entirely ready to have God remove all these defects of character. # Humbly asked Him to remove our shortcomings. # Made a list of all persons we had harmed, and became willing to make amends to them all. # Made direct amends to such people wherever possible, except when to do so would injure them or others. # Continued to take personal inventory and when we were wrong promptly admitted it. # Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out. # Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs. The organization of the society Alcoholics Anonymous has an informal control structure: there is no hierarchy of leaders. Guidelines for group conduct are outlined in the Twelve Traditions (below). A member who accepts a service position (an organizing role in a group) within the society is referred to as a trusted servant, a reference to Tradition 2. A member's commitment to service is held for a limited period, typically three months to one year, after which another member is chosen by a group vote. Individual members and groups cannot be compelled to do anything by higher AA authorities as each meeting, small or large, is considered a self-governing entity. At the local and national level, AA groups are self-supporting and not a charity. The society has no membership fees and does not charge to attend meetings, but instead relies on whatever donations members choose to give to cover basic costs such as room rental and refreshments. Contributions from members are limited to a maximum annual amount of $2000 per year, though most only donate $1 to $2 per meeting. Alcoholics Anonymous does receive proceeds from the sale of its book Alcoholics Anonymous, along with other published books and literature, which are periodically revised. Revenues from literature sales constitute more than 50% of the income for the General Service Office (GSO)GSO 2005 Operating Results, 'Gross Profit from Literature ~$6.7M (55%), Contributions ~$5.4M (45%)', which unlike individual groups is not self-supporting through contributions and does have a small number of salaried staff. Additional to the GSO, Alcoholics Anonymous also maintains a few service centers, which have the task of coordinating activities such as printing literature, responding to public inquiries, and organizing state or national conferences. Funded by local members, the centers are directly responsible to the AA groups in the region or country they represent. Alcoholics Anonymous is exclusively served by people who identify themselves as alcoholics with the exception that seven of the 21 members of the AA Board of trustees are listed as “nonalcoholic friends of the fellowship”The AA Fact File, 'The Structure of AA'. The 12 Traditions of Alcoholics Anonymous The affairs of Alcoholics Anonymous are governed broadly by AA's Twelve Traditions, suggested rules for organizing how the members and groups of the society interact with each other and with AA as a whole (see the book Twelve Steps and Twelve Traditions for more information''Twelve Steps and Twelve Traditions'', New York: Alcoholics Anonymous, 2003, ISBN 0-916856-06-2. ). These traditions were developed from experiences of the early groups during their first 13 years with the purpose of answering the questions "How can AA best function?" and "How can AA best stay whole and so survive?"Alcoholics Anonymous p 561 # Our common welfare should come first; personal recovery depends upon A.A. unity. # For our group purpose there is but one ultimate authority – a loving God as He may express Himself in our group conscience. Our leaders are but trusted servants; they do not govern. # The only requirement for A.A. membership is a desire to stop drinking. # Each group should be autonomous except in matters affecting other groups or A.A. as a whole. # Each group has but one primary purpose to carry its message to the alcoholic who still suffers. # An A.A. group ought never endorse, finance, or lend the A.A. name to any related facility or outside enterprise, lest problems of money, property, and prestige divert us from our primary purpose. # Every A.A. group ought to be fully self-supporting, declining outside contributions. # Alcoholics Anonymous should remain forever non-professional, but our service centers may employ special workers. # A.A., as such, ought never be organized; but we may create service boards or committees directly responsible to those they serve. # Alcoholics Anonymous has no opinion on outside issues; hence the A.A. name ought never be drawn into public controversy. # Our public relations policy is based on attraction rather than promotion; we need always maintain personal anonymity at the level of press, radio, and films. # Anonymity is the spiritual foundation of all our traditions, ever reminding us to place principles before personalities. AA's definition of alcoholism Although AA lacks an official, singular definition of alcoholism, Dr. William Silkworth contributed the chapter in the basic text of Alcoholics Anonymous entitled "The Doctor's Opinion." This chapter has become one of the more influential pieces in AA literature. In it, he wrote they "have one symptom in common: they cannot start drinking without developing the phenomenon of craving. This phenomenon, as we have suggested, may be the manifestation of an allergy which differentiates these people, and sets them apart as a distinct entity."Alcoholics Anonymous page xxx. The allergy takes the form of a craving, which is explained earlier in the chapter, "the phenomenon of craving is limited to this class alcoholics and never occurs in the average temperate drinker. These allergic types can never safely use alcohol in any form at all; and once having formed the habit ... they cannot break it..."Alcoholics Anonymous page xxviii. Contrary to Dr. Silkworth's original opinion, alcoholism does not actually constitute an allergy in the medical sense of the word, a fact acknowledged in later AA literature. "Technically, in strictly scientific terms, alcoholism is not a true allergy, the experts now inform us."Living Sober p 68 This explains why a spiritual experience (as opposed to a specific medical treatment, such as the use of antihistamines to treat an actual allergic reaction) is advocated in AA for achieving and maintaining sobriety. "When the spiritual malady is overcome, we straighten out mentally and physically." Alcoholics Anonymous p 64 Alcoholics Anonymous offers a solution that will create a "spiritual experience" or complete change in the person's outlook on life and alcoholism.Alcoholics Anonymous p 567 In the article Alcoholics Anonymous and the Disease Concept of Alcoholism, AA historian Ernest Kurtz wrote, "The closest the book Alcoholics Anonymous comes to a definition of alcoholism appears on p. 44, at the conclusion of the first paragraph of the 'We Agnostics' chapter, where we are told that alcoholism 'is an illness which only a spiritual experience will conquer'." This definition is the statement, "If, when you honestly want to, you find you cannot quit entirely, or if when drinking, you have little control over the amount you take, you are probably alcoholic."Alcoholics Anonymous p44 In 1960, Bill Wilson gave a speech to the National Catholic Clergy Conference on Alcoholism. During the ensuing question and answer discussion, Wilson was asked why he did not use the term disease when he spoke of alcoholism. He replied, "We AAs have never called alcoholism a disease because, technically speaking, it is not a disease entity. For example, there is no such thing as heart disease. Instead there are many separate heart ailments or combinations of them. It is something like that with alcoholism. Therefore, we did not wish to get in wrong with the medical profession by pronouncing alcoholism a disease entity. Hence, we have always called it an illness or a malady — a far safer term for us to use." Research on AA One reason that many researchers take a skeptical view of AA is that AA is so unscientific because of its spiritual basis.Vaillant, 1995, p 254. "Membership is voluntary and is determined by the individual, not by the group. There are no membership requirements except for the desire to stop drinking, no dues or fees, no membership lists. AA is notoriously difficult to pin down as an organization," writes Maria Gabrielle Swora.Maria Gabrielle Swora. "The rhetoric of transformation in the healing of alcoholism: The twelve steps of alcoholics anonymous." Mental Health, Religion & Culture, Sep2004, Vol. 7 Issue 3, p187-209. In his book Alcohol: The World's Favourite Drug, addiction specialist Griffith Edwards argues that a randomised trial of AA is not possible because members are self-selected, not randomly selected.Griffith Edwards. Alcohol: The World's Favourite Drug. 1st US ed. Thomas Dunne Books: 2002. ISBN 0-312-28387-3. pp 116 – 117. In other words, was AA the cause of their sobriety, or did they simply go to AA when they were ready to stop drinking? In spite of the obstacles to obtaining direct evidence, many researchers have tackled the problem of whether AA is effective at creating sobriety. Project MATCH Project MATCH was initiated in 1989 and was sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA).NIAAA Reports Project MATCH Main Findings, Press release from National Institute on Alcohol Abuse and Alcoholism, Dec 1996. Retrieved 2007-05-25. The project was an 8-year, multisite, $27-million investigation that asked whether certain types of alcoholics respond best to specific forms of treatment.Project Match Research Group. (1997). "Matching alcoholism treatments to client heterogeneity: Project MATCH Posttreatment drinking outcomes." Journal of Studies on Alcohol, 58(1), 7-29. MATCH notes "No single treatment approach is effective for all persons with alcohol problems. A more promising strategy involves assigning patients to alternative treatments based on specific needs and characteristics of patients." Three types of treatment were investigated: *Cognitive Behavioral Coping Skills Therapy, which focuses on correcting poor self esteem and distorted, negative, and self-defeating thinking.Treatment of alcoholism: New results. Harvard Mental Health Letter, Aug2006, Vol. 23 Issue 2, p6-7, 2pAdler, Jerry; Underwood, Anne; Kelley, Raina; Springen, Karen; Breslau, Karen. "Rehab Reality Check" Newsweek, 2/19/2007, Vol. 149 Issue 8, p44-46, 3p, 4c *Motivational Enhancement Therapy, which helps clients to become aware of and build on personal strengths that can help improve readiness to quit.Bruce Bower. Alcoholics synonymous: heavy drinkers of all stripes may get comparable help from a variety of therapies. Science News v151.n4 (Jan 25, 1997): pp62(2). *12-Step Facilitation Therapy administered as an independent treatment designed to familiarize patients with the AA philosophy and to encourage participation All the programs were administered by trained psychotherapists, which in the case of 12-step meant that it was the method and not AA itself that was studied. The conclusion of the research was that patient-treatment matching is not necessary in alcoholism treatment, because the three techniques were approximately equal in effectiveness. In a December 1996 press release, NIAAA Director Enoch Gordis, M.D. said "These findings are good news for treatment providers and for patients who can have confidence that any one of these treatments, if well-delivered, represents the state of the art in behavioral treatments." However overall success rates for all treatments were, and continue to be, less than spectacular. Based on information from Dr. Mark Willenbring of the NIAAA, Newsweek reported in their February 2007 issue that "A year after completing a rehab program, about a third of alcoholics are sober, an additional 40 percent are substantially improved but still drink heavily on occasion, and a quarter have completely relapsed."Adler et al. 2007 The study has been criticised by addiction expert Dr Stanton Peele as unscientific and politically motivated. Dr Peele stated that the outcomes of the study where at odds with abstinence based programs, as Project MATCH defined a "successful outcome" as a reduction (as opposed to cesation) of alcohol use.http://www.peele.net/lib/projmach.html, Stanton Peele article on Project MATCH floors, PsychNews International, Vol. 2, May-June 1997. George Vaillant Dr. George Vaillant is a board member of Alcoholics Anonymous World Service who in 1983 undertook a study to research the effectiveness of AA treatment. He compiled 40 years of clinical studies. He also conducted an eight-year longitudinal study of his own where Vaillant reported having followed 100 patients who had undergone Twelve-Step treatment. Vaillant compared those people to a group of several hundred other untreated alcohol abusers. The treated patients did no better than the untreated alcoholics. His studied showed that 95% of alcoholics who reach AA fail to stay sober. In his book The Natural History of Alcoholism Revisited, Harvard psychiatric professor George E. Vaillant posed seven key questions, the seventh of which was "How helpful is Alcoholics Anonymous in the Treatment of Alcoholism?"Vaillant, 1995, p 3 Vaillant's book was partly based on his experience with "a vast collaborative effort" that had started with two studies in the late 1930s and was still running after 60 years.Vaillant, 1995, pp vii and ix. Aware of the difficulties of obtaining direct evidence by statistical methods, he nevetheless states in his summary of literature and personal experience that "... research during the last 15 years has revealed growing indirect evidence that AA is an effective treatment for alcohol abuse." Vaillant, 1995, p 265 Despite his own statistics Vaillant continued to argue that AA shows an advantage over other treatments in the long term because, as a cheap, community-based fellowship it is easy for people to keep coming back. He argues that "AA is the most effective means of long-term relapse prevention in the physician’s armamentarium."Vaillant, 2005. He also writes that AA was formed by people deeply distrustful of organised religion, and that AA continues to pass the test of universalism by accepting members regardless of religious conviction. "Would that all 'religions' and fraternal organizations were as benign," he stated.Vaillant, 1995, p. 267. In 2005, Vaillant produced an extensive study of the efficacy and safety of AA in the treatment of alcoholism, reviewing the published works from 1940 until the present day. In this paper he acknowledges that, although AA is not a magic bullet for every alcoholic in that "there were a few men who attended AA for scores of meetings without improvement."George E. Vaillant. "Alcoholics Anonymous: cult or cure?" Australian & New Zealand Journal of Psychiatry, Jun2005, Vol. 39 Issue 6, p431-436., his overall observation is that "multiple studies that collectively involved a thousand or more individuals, suggest that good clinical outcomes are significantly correlated with frequency of AA attendance, with having a sponsor, with engaging in a Twelve-Step work and with chairing meetings." Despite a 95% failure rate Vaillant's overall conclusion is that "Alcoholics Anonymous appears equal to or superior to conventional treatments for alcoholism, and the skepticism of some professionals regarding AA as a first rank treatment for alcoholism would appear to be unwarranted."Vaillant, 2005 Moos and Moos In a 16-year follow-up study, Rudolf and Bernice Moos examined the effectiveness of clinical treatment and participation in AA."Participation in treatment and Alcoholics Anonymous: A 16-year follow-up of initially untreated individuals." By: Moos, Rudolf H.; Moos, Bernice S. Journal of Clinical Psychology, Jun2006, Vol. 62 Issue 6, p735-750. See also Moos and Moos. "Rates and predictors of relapse after natural and treated remission from alcohol use disorders." Addiction, 101, 212–222. And Moos and Moos, "Long-Term Influence of Duration and Frequency of Participation in Alcoholics Anonymous on Individuals with Alcohol Use Disorders." Journal of Consulting and Clinical Pyschology, 2004 Feb;72(1):81-90. (abstract, retrieved 2007-05-04) They reported that clients who had 27 weeks or more of treatment in the first year had better outcomes 16 years later. After the first year, continued clinical treatment had little effect on the 16-year outcomes, whereas continued involvement in AA did help. A conclusion was that "Some of the association between treatment and long-term alcohol-related outcomes appears to be due to participation in AA."Moos and Moos, 2006 The Veterans Study Moos, Mood, and Humphreys carried out a study of 1,774 low-income, substance-dependent men who had been enrolled in inpatient substance abuse treatment programs at 10 Department of Veteran Affairs medical centers around the U.S.Krista Conger. "Study points out value of 12-step groups in treating substance abuse." Stanford Report, May 23, 2001. Retrieved 2007-05-05.Five of the programs were 12-step based, and five used cognitive-behavioral therapy. The 12-step programs were found to be effective in terms of cost and recovery: over 45% of the men in 12-step programs were abstinent one year after discharge, compared to 36% of those treated by cognitive-behavioral therapy. In answer to the often-posed question as to which comes first, AA participation or reduced drinking, the study concluded that the answer is AA."How effective is Alcoholics Anonymous?" Harvard Mental Health Letter, Dec 2003, Vol. 20 Issue 6, p7-7.Moos said, however, that the benefits of participation in AA may not necessarily accrue to all types of individuals: "It is important to specify the characteristics of individuals who may not need to join AA in order to overcome their alcoholic-related problems.http://www.news-medical.net/?id=18958, Brandsma et al A study from 1979 found a correlation between AA and an increased rate of binge drinking. After several months of participating in AA, the alcoholics in AA were doing five times as much binge drinking as a control group that got no treatment at all, and nine times as much binge drinking as another group that got Rational Emotive Behavior Therapy. Brandsma argues that teaching people that they are alcoholics who are powerless over alcohol becomes a self-fulfilling prophecy.Brandsma, Jeffrey, Maxie Maultsby, and Richard J. Welsh. Outpatient Treatment of Alcoholism. Baltimore, MD.: University Park Press, 1979. p 105. Ditman et al. (1967) found a correlation between participation in AA and an increase in the alcoholics' rate of multiple arrests for public drunkenness. Keith S. Ditman, M.D., George G. Crawford, LL.B., Edward W. Forgy, Ph.D., Herbert Moskowitz, Ph.D., and Craig MacAndrew, Ph.D. (August 1967). "A Controlled Experiment on the Use of Court Probation for Drunk Arrests". American Journal of Psychiatry 124 (2): pp. 160-163. Research has indicated that alcoholics reporting a lack of motivation reverted to their drinking levels soon after leaving clinical treatment.Bower, Bruce. "AA's motivational benefits." Science News 152.n19 (Nov 8, 1997): 297(1). J. Scott Tonigan Tonigan's study found the largest benefit associated with AA attendance was increased abstinence, followed by reductions in alcohol-related consequences. "The magnitude of these benefits did not differ between sites." A slight positive association was also found between AA attendance and increased purpose in life – the study found that AA attendance was associated with psychosocial improvement.J. Scott Tonigan PhD. "Benefits of Alcoholics Anonymous Attendance" (University of New Mexico, 2001) pp 67 - 77 Criticism and controversy Moderation vs. abstinence The AA program is often challenged in the debate on cutting back versus total abstinence, "one of the most hotly contested issues in alcohol treatment".Nancy Shute. "The drinking dilemma: by calling abstinence the only cure, we ensure that the nation's $100 billion alcohol problem won't be solved". U.S. News & World Report v123 n9, Sept 8, 1997:pp54(10). Page 57. Treatment available in America, particularly, tends to lean towards total abstinence,Shute, 1997, p 57 & 60 even though not all problem drinkers are actually alcohol dependent.See alcohol abuse (a drinking pattern that causes problems) and alcohol dependence (i.e. alcoholism—an addiction and obsession) in the DSM-IV and the APA Dictionary of Psychology, 1st ed., Gary R. VandenBos, ed., Washington: American Psychological Association, 2007. AA has been criticized for recommending total abstinence as the only solution,Shute, 1997, p 61 however the AA "Big Book" does make it clear that the program is for alcoholics and that not all drinkers are alcoholics: "Moderate drinkers have little trouble in giving up liquor entirely if they have good reason for it. They can take it or leave it alone. ...type of person can also stop or moderate, although they may find it difficult and troublesome and may even need medical attention."Alcoholics Anonymous p 20-21. Nevertheless, it is likely that some AA members are over-zealous in recommending abstinence to all people with drinking problems. Disease concept of alcoholism The concept of alcoholism (and addiction) as a disease is controversial.Alan I. Leshner. "What does it mean that addiction is a brain disease?" Monitor on Psychology (American Psychological Association) Volume 32, No. 5 June 2001. AA regards alcoholism as a disease,''A Newcomer Asks (AA pamphlet)The Alcoholic Can Recover (AA pamphlet) and in practical terms AA often uses the concept to challenge the belief of some chronic, compulsive drinkers that they can stay sober by willpower alone.Alcoholics Anonymous p 30-31 AA has been criticized by opponents of the disease model, especially those who argue that some AA groups apply the disease model to all problem drinkers, whether or not they are full-blown alcoholics.Stanton Peele. The Diseasing of America. Lexington, MA: Lexington Books, 1989. Occasions of abuse at meetings AA groups have the benefits and risks of any community, and it is important to acknowledge that mutual support and abuse are both possible. There is no external restriction or vetting of AA members, and in fact the long-form version of Tradition 3 states that "Any two or three alcoholics gathered together for sobriety may call themselves an AA group..."http://www.aa.org/bigbookonline/en_appendiceI.cfm Newsweek reported on alleged cult-like and abusive behaviour in one controversial Washington DC AA group.Nick Summers. "A Struggle Inside AA." Newsweek. May 7, 2007. One of the women interviewed allegedly experienced pressure to have sex with senior members, and was told to cut off ties with anyone outside the group and to stop taking her antidepressant medication. However this woman reportedly moved to another AA group and was "relieved" to find these practices were not widespread and were contrary to AA philosophy. In the UK in 2000, the Guardian newspaper reported that a leaked internal AA memorandum stated that "volunteer members are increasingly being investigated by police forces examining allegations of sexual abuse."Gerard Seenan. "Drink advice service confronts sex abuse." The Guardian, July 5, 2000. According to the memo, a small minority of members were taking advantage of vulnerable new members who were seeking help by phone or by looking for a sponsor. At that time the AA service board was considering how to deal with the issue on a national level in the UK. Court mandated AA attendance Judges in the United States sometimes require attendance at AA meetings as a condition of probation or parole or as an element of a sentence for defendants convicted of a crime. "Open" AA meetings are open to anyone who wishes to attend, including those mandated by a court. Court ordered attendees have to answer to the judge, not to anyone in AA. Such forced attendance may not satisfy AA's Tradition 3, which says that "The only requirement for A.A. membership is a desire to stop drinking." Court decisions can be cited to support the argument that AA is based on religious activities. The New York Court of Appeals ruled in 1999 that mandating attendance at AA meetings compromises the Establishment Clause of the First Amendment right of those sentenced not to have religion dictated to them by government - because AA practices and doctrine are (in the words of the judge who wrote Griffin v. Coughlin ) "unequivocally religious". In that ruling it was also noted "adherence to the AA fellowship entails engagement in religious activity and religious proselytization." In "working" the Twelve Steps, participants become actively involved in seeking God through prayer, confessing wrongs and asking for "removal of shortcomings." The United States Supreme Court denied certiorari and let this decision stand. Grandberg v. Ashland County is another example concerning judicially-mandated AA attendance and the Establishment Clause. In that case the United States Court of Appeals for the Seventh Circuit ruled, "Alcoholics Anonymous materials and the testimony of the witness established beyond a doubt that religious activities, as defined in constitutional law, were a part of the treatment program. The distinction between religion and spirituality is meaningless, and serves merely to confuse the issue." In Warner v. Orange County Department of Probation a man convicted of drunk driving was sentenced to AA. The court found that the county was guilty of “coercing the plaintiff into participating in religious exercises, an act which tends toward the establishment of a state religious faith.” Accusations of cult practice Merriam-Webster defines a cult as "a system for the cure of disease based on dogma set forth by its promulgator". "Cult" in Merriam-Webster's Online Dictionary, M-W.com. As early as 1963, Alcoholics Anonymous has come under scrutiny as a possible cult. Dr Arthur H. Cain talked of the "religious flavour" the word sobriety had taken in AA, the "slavery" to the group and an over reliance on dogmatic slogans. Arthur H. Cain, "Alcoholics Anonymous: Cult or Cure?." Harper's Magazine, February 1963 It is said that AA's need for submission to a higher power leaves potential for abuse, and that that submission can become the basis for cult like cohesion Mark Dombeck, "Alcoholics Anonymous is a Cult?." MentalHelp.net, Jun 1st 2006. Retrieved 2007-07-23] . Various authors have stated that AA "uses all the methods of brain washing, which are also the methods employed by cults", "is able to suppress attitudes that could undermine its traditions" and "provides the prospective affiliate not merely with a solution to problems related to drinking, but also with an overarching world view with which the convert can and must reinterpret his or her past experience". Jeffrey A. Schaler. "Cult Busting" The InterPsych Newsletter Vol 2, Issue 5, June, 1995. Alcoholics Anonymous, in line with its own traditions, does not comment on accusations of cult behaviour in its groups. See also * Alcoholism **for alternate treatments to AA, see section Alcoholism:Politics and public health * Al-Anon/Alateen * Twelve-step program * Drunkenness * Substance abuse * Narcotics Anonymous * Cocaine Anonymous * Overeaters Anonymous * Alateen Further reading Books *''Alcoholics Anonymous : the story of how many thousands of men and women have recovered from alcoholism.'' 4th ed. New York : Alcoholics Anonymous World Services, 2001. ISBN 1893007162. Available online at www.AA.org and www.BigBook.org. *''Alcoholics Anonymous Comes of Age. A Brief History of AA'', New York: Alcoholics Anonymous, 1990, ISBN 0-916856-02-X. *''Living Sober: Some methods A.A. members have used for not drinking'', New York: Alcoholics Anonymous, 1975, 1998, ISBN 0-916856-04-6. *''Twelve Steps and Twelve Traditions'', New York: Alcoholics Anonymous, 2003, ISBN 0-916856-06-2. Articles * * * * * External links * Alcoholics Anonymous official website References Category:Alcohol abuse Category:Addiction Category:Drug rehabilitation Category:Twelve-step programs Category:Alcohol rehabilitation Category:Self-care Category:Community services